Evaluation of clinical prognosis of condylar intracapsular fractures in 65 children with conservative treatment using Helkimo index

doi:10.19438/j.cjoms.2020.05.008

Abstract

Abstract: PURPOSE: To evaluate the clinical prognosis of conservative treatment in children with condylar intracapsular fractures and explore different influencial factors including age, fracture type and treatment methods on the clinical prognosis. METHODS: A retrospective study was conducted in 65 children (96 sides) with condylar intracapsular fractures treated with conservative treatment from August 2009 to August 2019. The clinical prognosis assessed by Helkimo index (including Ai index and Di index) was analyzed, and compared respectively among different age group, fracture type and treatment methods. Non-parametric test was performed using SPSS 25.0 software package. RESULTS: Sixty patients (92.31%) had no obvious subjective symptoms (Ai 0 and Ai I), and 52 patients (80%) had normal clinical function or mild dysfunction (Di 0 and Di I). The differences in Ai levels between different age groups were statistically significant (P=0.001). Compared with 12-16 year old group, 0-5 year old group (P<0.05) and 6-11 year old group (P<0.05) both had better subjective clinical prognosis with smaller Ai index whereas age had no significant impact on Di index. There was no significant difference in Ai index between unilateral and bilateral fractures (P=0.178), different fracture types (P=0.139) and conservative treatment methods (P=0.121). Similarly, no significant difference was found in Di index between unilateral and bilateral fractures (P=0.321), different fracture types (P=0.692) and conservative treatment methods (P=0.944). CONCLUSIONS: Through conservative treatment, the clinical prognosis of condylar intracapsular fractures in children is proved to be good overall. The complaint of patients improves well though part of patients have mild dysfunction.

Key words: Condyle, intracapsular fracture, Children, Conservative treatment, Helkimo index

CLC Number:

R782.4

DU Chang-xin, XU Bing, ZHU Yan-fei, WANG Xue-chun, WU Yan-qi, ZHU Min. Evaluation of clinical prognosis of condylar intracapsular fractures in 65 children with conservative treatment using Helkimo index[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(5): 421-426.

References

[1] Kao R, Rabbani CC, Patel JM,et al.Management of mandible fracture in 150 children across 7 years in a US tertiary care hospital[J]. JAMA Facial Plast Surg, 2019, 21(5):414-418.
[2] Lekven N, Neppelberg E, Tornes K.Long-term follow-up of mandibular condylar fractures in children[J]. J Oral Maxillofac Surg, 2011, 69(11): 2853-2859.
[3] Namdev R, Jindal A, Bhargava S, et al.Patterns of mandible fracture in children under 12 years in a district trauma center in India[J]. Dent Traumatol, 2016, 32(1): 32-36.
[4] Wheeler J, Phillips J.Pediatric facial fractures and potential long-term growth disturbances[J]. Craniomaxillofac Trauma Reconstr, 2011, 4(1): 43-52.
[5] Ghasemzadeh A, Mundinger GS, Swanson EW, et al.Treatment of pediatric condylar fractures:a 20-year experience[J]. Plast Reconstr Surg, 2015,136(6):1279-1288.
[6] Ghosh R, Gopalkrishnan K, Anand J.Pediatric facial fractures:a 10-year study[J]. J Maxillofac Oral Surg, 2018, 17(2):158-163.
[7] He D, Ellis E 3rd, Zhang Y. Etiology of temporomandibular joint ankylosis secondary to condylar fractures:the role of concomitant mandibular fractures[J]. J Oral Maxillofac Surg, 2008, 66(1): 77-84.
[8] Leuin SC, Frydendall E, Gao D, et al.Temporomandibular joint dysfunction after mandibular fracture in children:a 10-year review[J]. Arch Otolaryngol Head Neck Surg, 2011,137(1): 10-14.
[9] McGoldrick DM, Parmar P, Williams R, et al. Management of pediatric condyle fractures[J]. J Craniofac Surg, 2019,30(7): 2045-2047.
[10] Bruckmoser E, Undt G.Management and outcome of condylar fractures in children and adolescents:a review of the literature[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012,114(5 Suppl): S86-S106.
[11] Zhou HH, Han J, Li ZB.Conservative treatment of bilateral condylar fractures in children:case report and review of the literature[J]. Int J Pediatr Otorhinolaryngol, 2014,78(9): 1557-1562.
[12] Shi J, Chen Z, Xu B.Causes and treatment of mandibular and condylar fractures in children and adolescents:a review of 104 cases[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(3): 203-207.
[13] Neff A, Chossegros C, Blanc JL, et al.Position paper from the IBRA Symposium on Surgery of the Head-the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012[J]. J Craniomaxillofac Surg, 2014,42(7):1234-1249.
[14] Kahl B, Fischbach R, Gerlach KL, et al.Temporomandibular joint morphology in children after treatment of condylar fractures with functional appliance therapy: a follow-up study us computed tomography[J]. Dentomaxillofac Radiol, 1995,24(1):37-45.
[15] Thoren H, Hallikainen D, Iizuka T, et al.Condylar process fractures in children:a follow-up study of fractures with total dislocation of the condyle from the glenoid fossa[J]. J Oral Maxillofac Surg, 2001,59(7):768-773.
[16] Helkimo M.Studies on function and dysfunction of the masticatory system.Ⅱ. Index for anamnestic and clinical dysfunction and occlusal state[J]. Sven Tandlak Tidskr, 1974, 67(2): 101-121.
[17] Umstadt HE, Ellers M, Muller HH, et al.Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation[J]. J Craniomaxillofac Surg,2000,28(2):97-105.
[18] 李新磊, 姚志涛, 王强, 等. 儿童髁突囊内骨折治疗方法选择的影响因素分析[J]. 口腔医学研究, 2017, 33(3): 290-294
[19] Hlawitschka M, Eckelt U.Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques[J]. J Oral Maxillofac Surg, 2002, 60(7): 784-791.
[20] 王生, 王光耀, 谷志远. Helkimo指数在颞下颌关节紊乱病研究中的应用[J].口腔颌面修复学杂志,2002, 3(2): 120-123.
[21] Defabianis P.Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group)[J]. J Clin Pediatr Dent, 2003, 27(4): 297-303.
[22] Sahm G, Witt E.Long-term results after childhood condylar fractures. A computer-tomographic study[J]. Eur J Orthod, 1989, 11(2): 154-160.
[23] Theologie-Lygidakis N, Chatzidimitriou K, Tzerbos F, et al.Nonsurgical management of condylar fractures in children:A 15-year clinical retrospective study[J]. J Craniomaxillofac Surg, 2016, 44(2): 85-93.
[24] 傅开元, 马旭臣, 张震康, 等. 颞下颌关节紊乱指数临床应用评价[J].中华口腔医学杂志, 2002, 37(5): 330-332.
[25] 邓雨萌,傅开元,刘亚萍,等.北京市207名3~5岁正常儿童开口度的调查报告[J].临床口腔医学杂志,1991,7(2): 119.
[26] Liu M, Zhao Y, He Y, et al.Outcomes of anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle in children after closed treatment[J]. Int J Oral Maxillofac Surg, 2020, 49(1): 82-89
[27] Chrcanovic BR.Open versus closed reduction:mandibular condylar fractures in children[J]. Oral Maxillofac Surg, 2012,16(3): 245-255.
[28] Norholt SE, Krishnan V, Sindet-Pedersen S, et al.Pediatric condylar fractures:a long-term follow-up study of 55 patients[J]. J Oral Maxillofac Surg, 1993, 51(12): 1302-1310.
[29] Gilhuus-Moe O.Fractures of the mandibular condyle:a clinical and radiographic examination of 62 patients injured in the growth period[J]. Trans Int Conf Oral Surg, 1970, 121-130.
[30] Choi J, Oh N, Kim IK.A follow-up study of condyle fracture in children[J]. Int J Oral Maxillofac Surg, 2005, 34(8): 851-858.
[31] Hovinga J, Boering G, Stegenga B.Long-term results of nonsurgical management of condylar fractures in children[J]. Int J Oral Maxillofac Surg, 1999, 28(6):429-440.
[32] Tang Y, Wang X, Zhu Y, et al.A Comparative evaluation of CBCT outcomes of two closed treatment methods in intracapsular condylar fractures[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017,123(5): e141-e147.
[33] 吴杨,龙星,邓末宏,等.颌间牵引联合垫治疗儿童髁突骨折的疗效评估[J].中国修复重建外科杂志, 2015, 29(4): 397-401.
[34] Egermark I, Thilander B.Craniomandibular disorders with special reference to orthodontic treatment: an evaluation from childhood to adulthood[J]. Am J Orthod Dentofacial Orthop, 1992,101(1): 28-34.